Communication is an integral part in the delivery of treatment to sick patients. In order to provide effective treatment plan, nurses must ensure that they have proper and effective communication skills. Nurses must also have the necessary skills to facilitate therapeutic communication. This kind of communication decreases the psychological distress that the patients may have and in a way, therapeutic communication raises the self worth of the patient if carefully undertaken. Engagement and rapport building, exchange of information and how an agreement action plan on the therapeutic process is also explained. This paper also takes a keep look at the communication phases that are involved in the therapeutic patient-client relationship. These phases include the introductory phase, the orientation phase, the working phase and the termination phase. The final part of this paper involves an action plan on how to create an effective communication development.
Therapeutic communication by the nurse should be done caringly and in a manner that is empathetic. This ensures that the patient feels that he is regarded positively by the nurse. The interaction in this therapeutic relationship occurs at the home of the patient. The time of the interaction is daily when the nurse goes to the patient’s home to offer medical treatment and checkups. In order for the therapeutic communication to be effective, the nurse has to maintain the confidentiality by not disclosing any information about the patient that is personal. Personal information can be disclosed by the nurse only in circumstances that the patient allows for the information to be shared so as meeting any therapeutic need of the client. The main reason for maintaining confidentiality and anonymity is to make the patients not to feel that their feelings are being diminished or that the confidential information is being used in a malicious manner.
In the hospital ward, I am normally in scenarios where I have to talk to children almost all the time. In my scenario as a nurse, I should be able to do my jobs in a professional manner and ensure that the patient’s private life is not brought to the limelight by crossing the set boundaries on the patient nurse relationship. As a nurse, I should be able to respect personal relationships of the client.
In the therapeutic nurse-patient relationship, there are basic communication skills that the nurse must place to ensure the conditions necessary for the nurse-patient relationship thrives. The communications skills that the nurse must use include; Engagement and rapport-building, Exchange of information and agreeing a negotiated plan (Daniels 2004, p. 165).
Engagement and rapport building is a major skill that a nurse is required to have. Rapport is a status in which a nurse has harmony, affinity and conformity with the patient. This creates a mutual liking between the patient and the nurse. The patient can open up to the nurse and provide information that the patient would have rather kept for himself. This personal information is shared by the patient if he feels that he can trust the nurse. Rapport consequently ensures that the patient has a connection with the nurse and an established bond is created between the two. In order for me to create rapport, I should be able to find common ground between myself and the patient. This common ground may be in the form of both of us being in the same situation but different ends. The patient requires treatment and the nurse are there to provide the treatment. In order communicating with the patient, the nurse can share the hobbies, values and beliefs of the patient or any other kind of information that interests both the nurse and the patient thus bringing them to the same platform.
As a nurse, I should also focus on the initial first impression towards the patient. My physical appearance creates a situation where I am able to connect with the patient. During the communication, which is face to face communication, between me and the patient, I should be in a position to use the patient’s perspective to my advantage and talk in an emphatic manner. In order to use empathy, as nurse, I should get to the child's level. Another way in which I can create rapport is through mirroring. As a nurse, I should be in a favorable point to understand the patient’s gestures and use them. When a patient is communicating by using simple language, the nurse should use the same simple language that the patient is using. This reassures the patient and makes them feel understood. Other basic techniques for building rapport such as looking at the patient directly in the eyes, smiling and asking open ended questions goes a long way in building rapport and shows compassion towards the patient.
In exchanging the information with the patient, I have to be careful in sharing the information with the patient about the treatment. I should share the information with the client about the numerous choices that are available to the patient so that the patient can make decisions that are informed. During the communication, I have to use non verbal communications techniques such as gestures and deliberate silence so as to encourage the patient to open up and disclose any additional information that the patient might be withholding. I should also be able show compassion towards the patient during our face to face communication by ensuring that I am concerned about the patient’s health. As a nurse, I should not delve extensively on the patient to disclose unwarranted information. The information that the nurse should obtain from the patient should be specific and in accordance with the patients therapeutic needs.
In agreeing to negotiate a plan, together with the patient, we should come up with an agreement that is concrete and that the plan should be a two way communication model. For the plan to be considered compassionate the client and the nurse should be willing to engage in a plan that focuses on the dreams of the client and the plan should be immediately implemented so that the patient does not feel ignored. The plan should be realistic and achievable so that the patient’s expectations are not overhyped, and the resources are not available for the required treatment.
In the client-patient therapeutic communication, there are four basic phases. These phases include the pre-interaction phase, the orientation or introductory phase, the working phase and the termination phase. The pre-interaction is a stage that normally begins even before the client meets the nurse. This phase involves gathering information about the patient that the nurse is going to work with. It is vital to note that the communication between the nurse and the client does not occur directly. The nurse conducts her research about the patient as he prepares for the client in the clinic. For the client, this first phase of therapeutic communication begins after the client has thought of seeking medical attention or the client has begun to seek for a healthcare system. To the client, this pre-interaction phase is normally a stage that is nervous and filled with lots of anxiety and expectations. For me as a nurse, this phase tends to enable me discover lots of information about myself and learn extensively about the patient.
While building compassion for the client, I should prepare for the feelings, fears and the fantasies that the client may possess. For this process to be successful, I should be confident in my face to face communication skills and possess a stable self-concept. In this stage, I should be analytical in the limitations and strengths of my job as a nurse. There are lots of problems that may be encountered in this phase by the nurse. The nurse may find it difficult to conduct a self analysis and the self acceptance of the patient. The nurse should possess good personality traits so as to avoid using the patient for personal fulfillment and interfering with the therapeutic success of the relationship. The skills used in this phase by the nurse shows lots of compassion especially when the nurse decides to work with a particular patient. The skill used in analyzing the patients anxiety ensures the nurse recognizes her strengths as well as the strengths of the patients. Basic therapeutic skills such as offering oneself can be a good example that shows compassion for the patient in that the nurse is willing to forfeit her time for the improvement of the patient.
The next phase is the introductory or the orientation phase. In this phase, it is significant to note that the nurse and the client meet for the first time. Sierra 1978, p.113 states that communication in therapeutic techniques such as observation and encouraging the use of descriptions of perceptions are vital in this phase. In order for me to show some compassion, I should talk to the patient about the reasons that led the patient to seek medical attention. It is in this stage that I should also establish a rapport with the client. The nurse should be attentive to detail and use different communication techniques that assist in the establishment of the trust, rapport and acceptance of the client. The expressions of thoughts and feelings that the client has should be clearly noted by the nurse so as to build a relationship that has a strong base. The information gathered about the client should be used by the nurse to understand the client’s feelings and the two parties meeting should be able to set up mutual goals on how the treatment should be done and priorities for intervention by the nurse should also be set. This phase, however, has some downsides. (Rosdahl and Kowalski 2008, p.41).
The therapeutic success of the treatment of the patient is highly dependable on the perceptions that the patient and the nurse have of each other. The nurse may perceive the patient as a normal patient and yet the patient requires some specific attention. Stereotyping and prejudices by the nurse should be avoided. Communications skills that are effective in this phase should allow the nurse to relate to her perceptions and feelings and to take any corrective actions in the case of presence of prejudices and take the analyzed data of the patient to the immediate supervisors. These skills are effective in that it allows the nurse to identify the patient’s feelings without making any criticism of the patient. It is at this point that the supervisors of the nurse will assist if the nurse seems to perceive the patient negatively. The nurse should change her perception if advised to do so by the supervisors.
The third phase in the therapeutic client-patient relationship is the working phase. At this phase, most of the work is carried out by the nurse. The nurse should develop a great insight on the patient. This can be done by assisting the patient to master his anxieties and to help the patient to increase interdependence by being given coping mechanism about the treatment after the nurse has linked the patient’s actions, feelings and perceptions. The nurse is also supposed to gather any extra additional information so as to facilitate behavioral change. Through the use of proper communication techniques, the nurse cans passionately advice the patient on the different opportunities to become independent and take charge. The nurse should also refine the goals that had been set in the orientation phase and make any changes that are necessary. The nurse may encounter several problems at this phase that the patient may test the nurse to find out the resolve of the nurse. The nurse may make unfavorable assumptions that the patient is progressing as expected. The nurse should not provide any signs of hostility or provocative remarks while with the patient as this would destroy the therapeutic client-patient relationship that has already been set.
The final phase is the termination phase. This phase is vital in that its main function is to end the therapeutic relationship between the nurse and the patient. Critical analytic skills must be used by the client when determining the criteria for terminating the relationship. The nurse has to determine if the patient’s psychology has improved and whether the patient can correctly claim that a sense of identity has been achieved. Proper communication skills are required to inform the patient about the reality of the termination of the relationship. This phase should only be terminated if the general objectives set at the pre-interaction phase have been achieved.
The first step in the development of effective communication skills is to understand that communication is a two way process and learning to listen is the most important part. In order for a person to learn to listen, the person should know the difference between hearing and listening. While communicating with the children in the hospital ward, I should be able to keenly listen to the words being spoken by the child so as to be able to understand some nonverbal messages in the talking process of the child. In this step, clarification and reflection techniques should be used to confirm what the child has said. The next step in this process is learning how to notice other people’s emotions during the conversation. It is proper to congratulate people on their successes and be sympathetic in the case the people have any misfortunes. Eye contact should be maintained during the conversation, and when addressing the children in the hospital ward, their first names of the children should be used. This makes the children feel valued especially when these children are asked for their opinions in the subject matter. Considering the effect of what one has to say on the emotions of the children should also be made.
Learning how to be emphatic is the third step to learn how to emphatic and thus learn how to view things from the other peoples point of view. Being judgmental and biased to other people’s ideas seems to make them feel bad and make prejudicial decisions. The sixth step is to encourage others during the conversations. (Lussier 2012, p. 56). This also allows for the other parties to voice over their concerns and feels valued. During the conversation, one should learn to use open-ended questions so as to encourage the other parties to speak freely. The other steps of the action plan are to try and integrate humor into ones speaking. This reduced the tension between the person talking and the audience. People should be treated equally in this action plan. No individuals should feel discriminated. When one is talking, it is not necessary to complain always. One should learn to complain when it is necessary.
There are several lessons that have been learnt during the course of this assignment. There are many communication skills that are required by the nurses in order to make a therapeutic client-patient relationship successful. As a nurse, one should be careful in understanding non verbal messages from the children. The communications skills that most nurses must possess can be classified into three groups. These groups include Engagement and rapport-building, Exchange of information and agreeing a negotiated plan. The development of the therapeutic client- patient relationship involves four steps that the nurses must master in order to ensure effective communication. These four phases must be followed critically, and corrections must be done after the reviews have been done to ensure a positive therapeutic client-patient relationship. There are many steps that are followed in the communication action plan to ensure effective communication skills are used especially when dealing with children.
SIERRA-FRANCO, M. (1978). Therapeutic communication in nursing. Montréal, McGraw-Hill.
DANIELS, R. (2004). Nursing fundamentals: caring & clinical decision making. Clifton Park, NY, Thomson/Delmar Learning.
ROSDAHL, C. B., & KOWALSKI, M. T. (2008). Textbook of basic nursing. Philadelphia, Lippincott Williams & Wilkins.
DEBORAH DALLEY, L. B. (2010). Developing your influencing skills: how to influence people by increasing. [S.l.], Universe Of Learning Ltd.
LUSSIER, R. N. (2012). Management fundamentals: concepts, applications, skill development. Mason, Ohio, South-Western.